Background The aim of this study was to determine the relationship between prosthesis coverage and postoperative hidden blood loss （HBL） in primary total knee arthroplasty （TKA）.Methods A total of 120 patients who...Background The aim of this study was to determine the relationship between prosthesis coverage and postoperative hidden blood loss （HBL） in primary total knee arthroplasty （TKA）.Methods A total of 120 patients who had undergone unilateral TKA from August 2012 to May 2013 were retrospectively studied.The Gross formula was used to calculate the amount of HBL.Routine standard anteroposterior （AP） and lateral x-ray films of the knee joint were taken postoperatively and used to measure the percentages of coronal femoral and of coronal and sagittal tibial prosthetic coverage.Then Pearson＇s correlation analysis was performed to assess the correlations between the percentages of prosthetic coverage for each AP and lateral position and HBL on the first and third postoperative days.Results The volumes of HBL on the first and third postoperative days after TKA were （786.5±191.6） ml and （1 256.6±205.1） ml,respectively,and lateral x-ray film measurements of percentages of coronal femoral,tibial coronal,and sagittal prosthetic coverage were （87.9±2.5）％,（88.5±2.2）％,and （89.1±2.3）％,respectively.Pearson＇s correlation analysis showed statistically significant correlations between percentages of total knee prosthetic coverage for each AP and lateral position and volumes of HBL on the first and third postoperative days （P ＜0.05）.Conclusions HBL after TKA correlates with degree of prosthetic coverage.To some extent,the size of the surfaces exposed by osteotomy determines the amount of HBL.Choice of the appropriate prosthesis can significantly reduce postoperative HBL.Designing individualized prostheses would be a worthwhile development in joint replacement surgery.展开更多
背景:全髋关节置换是治疗强直性脊柱炎累及髋关节破坏的有效措施,强直性脊柱炎患者全髋关节置换后有不同程度的贫血,而隐性失血在全髋关节置换围手术期失血量占有较大比例,影响关节功能的恢复。目的:分析强直性脊柱炎髋关节受累患者接...背景:全髋关节置换是治疗强直性脊柱炎累及髋关节破坏的有效措施,强直性脊柱炎患者全髋关节置换后有不同程度的贫血,而隐性失血在全髋关节置换围手术期失血量占有较大比例,影响关节功能的恢复。目的:分析强直性脊柱炎髋关节受累患者接受全髋关节置换后隐性失血的危险因素。方法:人工全髋关节置换治疗的60例(70髋)强直性脊柱炎累及髋关节的患者,平均年龄35.12岁。根据Gross方程计算隐性失血量,收集和分析手术时间、血沉、C-反应蛋白、体质量指数、是否骨质疏松、强直性脊柱炎髋关节放射指数、异体输血量等对患者全髋关节置换后隐性失血的影响,并按隐性失血量分为高隐性失血组(≥480 m L)和低隐性失血组(<480 mL),通过单因素相关分析及多因素Logistic回归分析(SPSS17.0)影响强直性脊柱炎患者初次全髋关节置换术后高隐性失血的危险因素。结果与结论:(1)患者初次全髋关节置换后隐性失血量为(737.76±419.18)mL,总失血量为(1 312.83±487.41)mL,隐性失血占总失血量的51.48%。高隐性失血组41髋,低隐性失血组29髋,比例为41∶29;(2)单因素相关分析结果显示手术时间、强直性脊柱炎髋关节放射指数、是否骨质疏松、异体输血量、血红蛋白下降量与高隐性失血显著相关;(3)多因素Logistic回归分析结果显示强直性脊柱炎髋关节放射指数、异体输血量、血红蛋白下降量与高隐性失血显著相关;(4)结果说明,隐性失血量是强直性脊柱炎患者初次全髋关节置换后总失血量的重要组成部分,强直性脊柱炎髋关节放射指数、异体输血量、血红蛋白下降量是高隐性失血的危险因素。展开更多
Background： Currently, various calculation methods for evaluating blood-loss in patients with total knee arthroplasty （TKA） are applied in clinical practice. However, different methods may yield different results. ...Background： Currently, various calculation methods for evaluating blood-loss in patients with total knee arthroplasty （TKA） are applied in clinical practice. However, different methods may yield different results. The purpose of this study was to determine the most reliable method for calculating blood-loss after primary TKA. Methods： We compared blood-loss in 245 patients who underwent primary unilateral TKA from February 2010 to August 2011. We calculated blood-loss using four methods： Gross equation, hemoglobin （Hb） balance, the Orthopedic Surgery Transfusion Hemoglobin European Overview （OSTHEO） formula, and Hb-dilution. We determined Pearson＇s correlation coefficients for the four methods. Results： There were large differences in the calculated blood-loss obtained by the four methods. In descending order of combined correlation coefficient based on calculated blood-loss, the methods were Hb-balance, OSTHEO formula, Hb-dilution, and Gross equation. Conclusions： The Hb-balance method may be the most reliable method of estimating blood-loss after TKA.展开更多
背景:既往研究发现脂肪细胞的增加伴随着骨密度和骨量的减少,而脂肪细胞的分化受细胞外信号调节激酶(extracellular regulated protein kinases,ERK)1/2信号通路的影响。目前骨质疏松患者不同证型脂代谢中ERK1/2的表达特点及其相关性研...背景:既往研究发现脂肪细胞的增加伴随着骨密度和骨量的减少,而脂肪细胞的分化受细胞外信号调节激酶(extracellular regulated protein kinases,ERK)1/2信号通路的影响。目前骨质疏松患者不同证型脂代谢中ERK1/2的表达特点及其相关性研究较少,因此设计此试验研究其中内在联系。目的:探讨老年性骨质疏松症中医证型与ERK的相关性及特点。方法:对符合要求的94例老年骨质疏松症患者进行中医证型分组,其中肝肾亏虚型39例、脾肾阳虚型30例、气滞血瘀型25例。患者入院第2天,采集晨起空腹外周静脉血,检测总胆固醇、三酰甘油、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、载脂蛋白A1、载脂蛋白B水平。一般患者入院第3天行人工髋关节置换术留取股骨颈开路挖出的松质骨标本,置于冻存管-80℃保存,采用Western blot检测股骨颈髓腔松质骨中ERK1/2及p-ERK1/2的蛋白表达量。结果与结论:①3种证候类型骨质疏松症患者的血清三酰甘油、高密度脂蛋白胆固醇及低密度脂蛋白胆固醇水平相比,差异有显著性意义(P<0.05)。脾肾阳虚型骨质疏松症患者血清三酰甘油水平高于肝肾亏虚型及气滞血瘀型(P=0.009,P=0.035);肝肾亏虚型骨质疏松症患者血清高密度脂蛋白胆固醇水平高于脾肾阳虚型及气滞血瘀型(P=0.004,P=0.017);气滞血瘀型骨质疏松症患者血清低密度脂蛋白胆固醇水平低于脾肾阳虚型及肝肾亏虚型(P=0.009,P=0.003)。②气滞血瘀型骨质疏松症患者松质骨p-ERK1及p-ERK2水平高于脾肾阳虚型及肝肾亏虚型(p-ERK1:P=0.000,P=0.000;p-ERK2:P=0.024,P=0.000),肝肾亏虚型骨质疏松症患者p-ERK2水平高于脾肾阳虚型(P=0.006)。③脾肾阳虚型与三酰甘油值呈正相关(r=0.124,P=0.006),与p-ERK1/2值呈负相关(r=-0.512,P=0.013);气滞血瘀型与p-ERK1/2值呈正相关(r=0.331,P=0.000);④结果表明,脾肾阳虚型骨质疏松症患者脂代谢与其他2种类�展开更多
基金This project was partially supported by a grant from the National Natural Science Foundation of China （No.81273972）.
文摘Background The aim of this study was to determine the relationship between prosthesis coverage and postoperative hidden blood loss （HBL） in primary total knee arthroplasty （TKA）.Methods A total of 120 patients who had undergone unilateral TKA from August 2012 to May 2013 were retrospectively studied.The Gross formula was used to calculate the amount of HBL.Routine standard anteroposterior （AP） and lateral x-ray films of the knee joint were taken postoperatively and used to measure the percentages of coronal femoral and of coronal and sagittal tibial prosthetic coverage.Then Pearson＇s correlation analysis was performed to assess the correlations between the percentages of prosthetic coverage for each AP and lateral position and HBL on the first and third postoperative days.Results The volumes of HBL on the first and third postoperative days after TKA were （786.5±191.6） ml and （1 256.6±205.1） ml,respectively,and lateral x-ray film measurements of percentages of coronal femoral,tibial coronal,and sagittal prosthetic coverage were （87.9±2.5）％,（88.5±2.2）％,and （89.1±2.3）％,respectively.Pearson＇s correlation analysis showed statistically significant correlations between percentages of total knee prosthetic coverage for each AP and lateral position and volumes of HBL on the first and third postoperative days （P ＜0.05）.Conclusions HBL after TKA correlates with degree of prosthetic coverage.To some extent,the size of the surfaces exposed by osteotomy determines the amount of HBL.Choice of the appropriate prosthesis can significantly reduce postoperative HBL.Designing individualized prostheses would be a worthwhile development in joint replacement surgery.
文摘背景:全髋关节置换是治疗强直性脊柱炎累及髋关节破坏的有效措施,强直性脊柱炎患者全髋关节置换后有不同程度的贫血,而隐性失血在全髋关节置换围手术期失血量占有较大比例,影响关节功能的恢复。目的:分析强直性脊柱炎髋关节受累患者接受全髋关节置换后隐性失血的危险因素。方法:人工全髋关节置换治疗的60例(70髋)强直性脊柱炎累及髋关节的患者,平均年龄35.12岁。根据Gross方程计算隐性失血量,收集和分析手术时间、血沉、C-反应蛋白、体质量指数、是否骨质疏松、强直性脊柱炎髋关节放射指数、异体输血量等对患者全髋关节置换后隐性失血的影响,并按隐性失血量分为高隐性失血组(≥480 m L)和低隐性失血组(<480 mL),通过单因素相关分析及多因素Logistic回归分析(SPSS17.0)影响强直性脊柱炎患者初次全髋关节置换术后高隐性失血的危险因素。结果与结论:(1)患者初次全髋关节置换后隐性失血量为(737.76±419.18)mL,总失血量为(1 312.83±487.41)mL,隐性失血占总失血量的51.48%。高隐性失血组41髋,低隐性失血组29髋,比例为41∶29;(2)单因素相关分析结果显示手术时间、强直性脊柱炎髋关节放射指数、是否骨质疏松、异体输血量、血红蛋白下降量与高隐性失血显著相关;(3)多因素Logistic回归分析结果显示强直性脊柱炎髋关节放射指数、异体输血量、血红蛋白下降量与高隐性失血显著相关;(4)结果说明,隐性失血量是强直性脊柱炎患者初次全髋关节置换后总失血量的重要组成部分,强直性脊柱炎髋关节放射指数、异体输血量、血红蛋白下降量是高隐性失血的危险因素。
文摘Background： Currently, various calculation methods for evaluating blood-loss in patients with total knee arthroplasty （TKA） are applied in clinical practice. However, different methods may yield different results. The purpose of this study was to determine the most reliable method for calculating blood-loss after primary TKA. Methods： We compared blood-loss in 245 patients who underwent primary unilateral TKA from February 2010 to August 2011. We calculated blood-loss using four methods： Gross equation, hemoglobin （Hb） balance, the Orthopedic Surgery Transfusion Hemoglobin European Overview （OSTHEO） formula, and Hb-dilution. We determined Pearson＇s correlation coefficients for the four methods. Results： There were large differences in the calculated blood-loss obtained by the four methods. In descending order of combined correlation coefficient based on calculated blood-loss, the methods were Hb-balance, OSTHEO formula, Hb-dilution, and Gross equation. Conclusions： The Hb-balance method may be the most reliable method of estimating blood-loss after TKA.
文摘背景:既往研究发现脂肪细胞的增加伴随着骨密度和骨量的减少,而脂肪细胞的分化受细胞外信号调节激酶(extracellular regulated protein kinases,ERK)1/2信号通路的影响。目前骨质疏松患者不同证型脂代谢中ERK1/2的表达特点及其相关性研究较少,因此设计此试验研究其中内在联系。目的:探讨老年性骨质疏松症中医证型与ERK的相关性及特点。方法:对符合要求的94例老年骨质疏松症患者进行中医证型分组,其中肝肾亏虚型39例、脾肾阳虚型30例、气滞血瘀型25例。患者入院第2天,采集晨起空腹外周静脉血,检测总胆固醇、三酰甘油、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、载脂蛋白A1、载脂蛋白B水平。一般患者入院第3天行人工髋关节置换术留取股骨颈开路挖出的松质骨标本,置于冻存管-80℃保存,采用Western blot检测股骨颈髓腔松质骨中ERK1/2及p-ERK1/2的蛋白表达量。结果与结论:①3种证候类型骨质疏松症患者的血清三酰甘油、高密度脂蛋白胆固醇及低密度脂蛋白胆固醇水平相比,差异有显著性意义(P<0.05)。脾肾阳虚型骨质疏松症患者血清三酰甘油水平高于肝肾亏虚型及气滞血瘀型(P=0.009,P=0.035);肝肾亏虚型骨质疏松症患者血清高密度脂蛋白胆固醇水平高于脾肾阳虚型及气滞血瘀型(P=0.004,P=0.017);气滞血瘀型骨质疏松症患者血清低密度脂蛋白胆固醇水平低于脾肾阳虚型及肝肾亏虚型(P=0.009,P=0.003)。②气滞血瘀型骨质疏松症患者松质骨p-ERK1及p-ERK2水平高于脾肾阳虚型及肝肾亏虚型(p-ERK1:P=0.000,P=0.000;p-ERK2:P=0.024,P=0.000),肝肾亏虚型骨质疏松症患者p-ERK2水平高于脾肾阳虚型(P=0.006)。③脾肾阳虚型与三酰甘油值呈正相关(r=0.124,P=0.006),与p-ERK1/2值呈负相关(r=-0.512,P=0.013);气滞血瘀型与p-ERK1/2值呈正相关(r=0.331,P=0.000);④结果表明,脾肾阳虚型骨质疏松症患者脂代谢与其他2种类�
